Head and Neck Cancer

Question 1

what should be done pre treatment for cancer patients

Answer 1

• establish adequate OH
• give oral and denture hygiene advice.
• fluoride varnish and high fluoride toothpaste
• eliminate infection and definitively restore carious teeth
• extractions at least 10 days prior to starting treatment

Question 2

oral mucositis

Answer 2

inflammation of the oral mucosa leading to ulceration
begins 1-2 weeks after treatment starts and can last up to 6 weeks post treatment

Question 3

prevention and management of oral mucositis

Answer 3

prevention - possibly cryotherapy
management - caphosol, gelclair, difflam spray, aloe vera
opioid analgesics effective
good OH wont help symptoms but will help heal faster

(CHX not recommended)

Question 4

name 4 treatment side effects of cancer therapy that are seen during treatment

Answer 4

oral mucositis
traumatic ulceration
reactivation of herpes simplex
candida infections (cancer team often prescribes antifungals)

Question 5

name 3 things that increases risk of ORN

Answer 5

• total dose >60Gy
• patient immunodeficient
• patient malnourished
• high dose fraction and high number of fractions

Question 6

if a neck lump is found what is the imaging of choice

Answer 6

ultrasound

Question 7

what features of a node on an ultrasound may raise concern of pathology (3)

Answer 7

• round rather than oval
• more than 10cm
• conglomerate nodes (matted together)

Question 8

what findings on a radiograph may increase suspicion of bone cancer (3)

Answer 8

• floating teeth
• non healing sockets
• generalised widening of PDLs and loss of lamina dura

Question 9

what antifungal is not an effective treatment in candidiasis caused by cancer treatment

Answer 9

nystatin

Question 10

ORN

Answer 10

area of exposed bone persisting more than 3 months in an irradiated site that is not due to tumour recurrence
those at high risk may recieve antibiotic prophylaxis cover prior to extractions